ABSTRACT
The principles identified by the King's Fund in 1992 as the basis for change in London would not have been problematic for those who argued for a national health service half a century ago. London's health services must be planned and managed to serve the population rather than to perpetuate institutions, and Londoners should be much more actively involved in their own health and health care. Indeed one of the King's Fund Commission's conclusions restates some of the key arguments in favour of a national health service. New technologies and techniques afford opportunities for more effective use of expensive hospital resources. The attempts to deliver high quality health care for London were frustrated by the difficulty of maintaining high clinical ideals underpinned by values of equity, of unimpeded access and high quality outcomes in the context of scarce resources and established institutions.
